Healthcare Provider Details

I. General information

NPI: 1679703813
Provider Name (Legal Business Name): MULTICULTURAL RESOURCES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 KENNASAW DR
FAYETTEVILLE NC
28314-5757
US

IV. Provider business mailing address

980 KENNASAW DR
FAYETTEVILLE NC
28314-5757
US

V. Phone/Fax

Practice location:
  • Phone: 910-864-7729
  • Fax: 910-864-5389
Mailing address:
  • Phone: 910-864-7729
  • Fax: 910-864-5389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARCIA ANGELA HAYES
Title or Position: FINANCE SECRETARY
Credential:
Phone: 910-864-7729